In Reply: Dr Stamato raises interesting issues regarding interpretation and implementation of clinical trial results. We agree that it is important to consider the types of patients who were enrolled in clinical trials when considering the generalizability of these trial findings. Clinicians treat individual patients who have complex combinations of characteristics, rather than the groups of patients that are the basis of clinical trial results.1 Stamato is correct that patients in the major ICD trials tended to be younger and to have fewer comorbid conditions than heart failure patients in community practice.2
Hernandez AF, Fonarow GC, Peterson ED. Implantable Cardioverter-Defibrillators, Heart Failure, and Patient Characteristics—Reply. JAMA. 2008;299(3):285–286. doi:10.1001/jama.299.3.286-a
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